Hodgkin and Non-Hodgkin Lymphomas

Abstract

Prognostic Indices Used in Non-Hodgkin and Hodgkin Lymphoma. International Prognostic Index (IPI). The International Non-Hodgkin Lymphoma Prognostic Factors Project used pretreatment prognostic factors in a sample of several thousand patients with aggressive lymphomas treated with doxorubicin-based combination chemotherapy to develop a predictive model of outcome for aggressive non-Hodgkin lymphoma. The specific type of lymphoma and the IPI score are the major factors currently used in treatment decisions. On the basis of factors identified in multivariate analysis of the above data set, the International Prognostic Index was proposed. Five pretreatment characteristics were found to be independent statistically significant factors: age in years (<60 vs. >60); tumor stage I or II (localized) versus III or IV (advanced); number of extranodal sites of involvement (0–1 vs. >1); patient’s performance status (ECOG 0 or 1 vs. ≥2); and serum LDH level (normal vs. abnormal). With the use of these five pretreatment risk factors, patients could be assigned to one of the four risk groups on the basis of the number of presenting risk factors: low (0 or 1), low intermediate (2), high intermediate (3), and high (4 or 5). When patients were analyzed by risk factors, they were found to have very different outcomes with regard to complete response (CR), relapse-free survival (RFS), and overall survival (OS). The outcomes indicated that the low-risk patients had an 87% CR rate and an OS rate of 73% at 5 years in contrast to a 44% CR rate and 26% 5-year survival in patients in the high-risk group. A similar pattern of decreasing survival with a number of adverse factors was observed when younger patients only were considered.

(Excludes ocular adnexal lymphoma)